The prevalence of childhood overweight and obesity is high and has negative health implications during childhood and adulthood. Prevention and effective treatment are important to reduce risks of adult obesity, type 2 diabetes and cardiovascular disease. Physical activity (PA) can influence the incidence of overweight, obesity and co-morbidities in children. There is a need to increase PA in children before the period of decline of PA seen in older youth. Video game play is established in the daily life of children and is therefore a potential channel for introducing healthy behaviors, but is also a source of inactivity. Active video games can increase energy expenditure to intensities that meet PA guidelines for children, but there is insufficient evidence regarding their ability to positively affect PA time, or maintain active game play over longer periods. Active video games could attract players and sustain their involvement. Population participation levels in PA are low, indicating that PA has not proven to be an intrinsically motivating activity for the majority of the population. Active video games were designed to be enjoyable, but their hedonic value does not rely on the activity component. The enjoyment of active video games may contribute to increasing PA levels in children, especially in neighborhoods considered unsafe, where the children are not allowed outside. The present study aims to investigate (1) the temporal trajectory from point of accession of active and inactive video game play in the home environment, (2) the effect of active video game play on overall PA and BMI, (3) effects of motivational variables, perceived neighborhood safety, media parenting practices and the home media environment on game play, and (4) what video game characteristics encourage sustainability of play. Eighty children and their primary caregivers will participate in an 18-week randomized control trial (active or inactive video game) stratified by parent perceived safe or unsafe neighborhood. Participating families will be given a video game console and two active or inactive video games: one at the beginning of the first 6-week period and another at the beginning of the second 6-week period. PA levels of participating children will be measured using accelerometry the week prior to the introduction of the video game and on weeks 1, 6, 7, 12, 13 and 18. They will keep a log of video game play on weeks 1, 6, 7 and 12. Objective video game play time will be transcribed at the end of weeks 6, 12 and 18 from information stored in the console. A questionnaire designed to examine the motivation to play a video game (end of weeks 6 and 12) and brief qualitative interviews on the children's experiences with the games (end of weeks 6, 12 and 18) will be administered. The project team combines expertise in video game play, behavioral change in children, measurement of PA, qualitative interviews and data analysis. PUBLIC HEALTH RELEVANCE: Sustainable physical activity is a key component of prevention programs to combat the epidemic of obesity in children. Video games are a highly popular activity. This project will examine the sustainability of active video game play in the home environment and motivation of children to play these games.